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TRAUMA
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Trauma Triage:
The Right Patient in the Right Hospital at the Right Time
by Matthew R. Rosengart, MD, MPH
Trauma affects one out of five Americans, requiring the expenditure
of $400 billion in direct medical costs each year. Regionalizationtiered levels of care that distribute the sickest patients to the highest
intensity hospitals (trauma centers) reduce mortality and morbidity1,2.
In fact, regionalization in trauma has become the standard of care,
and evidence suggests that inclusive trauma systems improve
outcomes by matching patient needs with institutional resources.
Ideally, therefore, patients with moderate to severe injuries should
receive care at trauma centers (TC), while those with minor injuries
should receive care at non-trauma centers (NTCs).
Thirty years ago, The American College of Surgeons Committee on
Trauma (ACS-COT) published guidelines for the triage of trauma
patients. Providers at outlying hospitals could use a simple algorithm
to identify patients with moderate to severe injuries, who would
benefit from transfer to a Level I/II trauma center. Emphasizing the
principle of triage, the proposed algorithm relied on information
gathered with a history, physical examination, chest x-ray and pelvis
x-ray. These well-established clinical practice guidelines specify
when to triage patients to specialty trauma centers (Figure 1).
Despite evidence that ACS-COT guidelines improve morbidity and
mortality, as well as concerted efforts to address known barriers to
compliance, some patients who meet criteria for transfer to a TC
remain at NTCs, referred to as under-triage3. Other studies have
reported a large proportion of severely injured patients with signs of
physiologic compromise (for example, hypotension and tachycardia)
undergo CT scan imaging at community hospitals prior to transfer
to a TC4. Interestingly, in this study pretransfer scans did not change
TR AUM A RO U N DS
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Jacobs LM, Wade DS, McSwain NE, Butler FK, Fabbri WP, Eastman AL,
Rotondo M, Sinclair J, Burns KJ. The Hartford Consensus: THREAT, a
medical disaster preparedness concept. J Am Coll Surg. 2013
Nov;217(5):947-53.
Bulger EM, Snyder D, Schoelles K, Gotschall C, Dawson D, Lang E, Sanddal
ND, Butler FK, Fallat M, Taillac P, White L, Salomone JP, Seifarth W,
Betzner MJ, Johannigman J, McSwain N Jr. An evidence-based prehospital
guideline for external hemorrhage control: American College of Surgeons
Committee on Trauma. Prehosp Emerg Care. 2014 Apr-Jun;18(2):163-73.
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Course Name
Date(s)
Contact
Jennifer Maley
maleyjl@upmc.edu
412-647-8115
Noel Faust-Vislay
faustn@upmc.edu
412-232-7114
References
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